PT - JOURNAL ARTICLE AU - Sripad, Pooja AU - Peterson, Summer AU - Idrissou, Daoudou AU - Kamanga, Martha AU - Kezembe, Abigail AU - Ndwiga, Charity AU - Okondo, Chantalle AU - Ranjalahy, Anja Noeliarivelo AU - Stevanovic-Fenn, Natacha AU - Warren, Charlotte E. AU - Zieman, Brady AU - Mathur, Sanyukta TI - Applying a Power and Gender Lens to Understanding Health Care Provider Experience and Behavior: A Multicountry Qualitative Study AID - 10.9745/GHSP-D-22-00420 DP - 2023 Nov 30 TA - Global Health: Science and Practice PG - e2200420 VI - 11 IP - Supplement 1 4099 - http://www.ghspjournal.org/content/11/Supplement_1/e2200420.short 4100 - http://www.ghspjournal.org/content/11/Supplement_1/e2200420.full SO - GLOB HEALTH SCI PRACT2023 Nov 30; 11 AB - Key FindingsHealth care providers' (HCPs') power to deliver high-quality care is influenced by perceptions of relationships and interactions with clients, families, peers, and supervisors, as well as interprovider collaboration and community norms.HCPs' power is constrained by restrictive or shifting institutional policy and limited access to resources, advancement opportunities, and supportive supervision.Interprovider power dynamics suggest that too much HCP power over can sometimes be as consequential as a lack of power to providing quality care.Community- and facility-based HCPs' perspectives suggest variable power-enhancing approaches are needed to positively affect a client's experienced quality of care.Key ImplicationsProgram stakeholders should consider participatory mechanisms for routine community feedback (positive and negative) to improve the client-provider interaction experiences.Facility managers should consider team-building strategies to overcome challenging interprovider dynamics and reinforce collaboration and trust.Policymakers and national stakeholders should consider HCPs' power-influencing factors within provider behavior change efforts, including allocations for equitable access to resources and supervision, provider growth opportunities, and guidance for task-sharing.A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains—beliefs and perceptions; practices and participation; access to assets; and structures—to explore how these constructs are differentially experienced based on one's gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n=123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs' power derives from the nature and quality of their relationships with clients and the community. Providers' power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs' power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power—and secondarily, gender lenses—can elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs.